| EXECUTIVE OFFICE | RESPONSIBILITIES | CONTACT NUMBERS |
| National Health Administrators, Inc. P. O. Box 5000 Endicott, NY 13761-5000 |
Questions on Benefits, Claims, Membership,
or Provider verification of benefits. See also Compliance Office for Claims Appeals below. |
Hotline: (888) 679-2400 EXT 1 Phone: (888) 335-0133 Fax: (607) 786-3437 claims@nhai.net |
| NHAI Behavioral (NHAB) Claims (Mental
Health/Substance Abuse) 246 RTE. 34 South, Matawan, NJ 07747 |
All claims for mental health and substance
abuse must be filed directly with the NHAI Behavioral Claims Office.
NHAB is the Exclusive Provider for Mental Health & Addictive Treatment. Non-approved providers or services will not be covered. |
Hotline: (888) 679-2400, EXT 3 Phone: (888) 838-8874, Fax: 732-441-9866 E-mail: behavioral@nhai.net |
| National Health Administrators , Inc.
PPO 1200 Brown Street Suite 12 Peekskill, NY 10566 Normal Business Hours, except for Holidays: 9 a.m. - 5 p.m. |
PPO providers are available at the following
Web Site For Information Packet on NHAI PPO, or to Find local providers
& other general questions. www.nhai.net PPO Provider Relations, PPO Negotiations, and all PPO Contracting and pricing. Problems with providers. |
Hotline: (888) 679-2400, Ext.103 Fax: (914) 739-8341 |
| OUT OF STATE PPO PROVIDERS | RESPONSIBILITIES | CONTACT NUMBERS |
| NHAI has a number of providers in Florida, Connecticut and other states. Please check the provider listing at our web site.Out of State or traveling members call Multiplan for Physicians or facility referrals (800) 557-6794. | For emergencies, go to the nearest hospital. Go to web site to see if there are PPO Providers in area. PPO directories are available from Trust Office. | Contact PPO Office for InformationHotline:
(888) 679-2400, Ext.103 Fax: (914-739-8341 Out of State Referrals:Multiplan: (800) 557-6794 |
| PRE-CERTIFICATION | RESPONSIBILITIES | CONTACT NUMBERS |
Pre-Cert Department IN AN EMERGENCY GO TO NEAREST HOSPITAL IMMEDIATELY !! |
For Pre-certification, Utilization Review, Case Management for Medical, Mental Health TreatmentPre-certification decisions are independent from payment or benefit decisions. | Hotline: (888) 679-2400, Ext 2 Phone: (866) 844-8244 Fax: (785) 233-3149 E-mail: precert@nhai.net |
| NHAI Behavioral (NHAB)(Exclusive Provider for all behavioral treatment) | NHAB must authorize all mental health and substance abuse services. Benefits must also be pre-certified by Century Health Solutions. IN CASE OF EMERGENCY, GO TO THE NEAREST HOSPITAL! | Hotline: (888) 679-2400, EXT 3 Phone: (888) 838-8874 Fax: (732) 441-9866 |
| PRESCRIPTIONS - Rx | RESPONSIBILITIES | CONTACT NUMBERS |
| Medco Health Solutions – your group health id card is also your rx card to purchase retail drugs | For retail and mail order programs or to find a local network pharmacy.For special Rx requests, problems, or vacation override on medication, contact the Compliance Office or the Executive Offices of NHAI, Extension 6, than Extension 5. | Member Service& Rx Card: (800) 818-0093 Mail Order Rx: (800) 727-6141 Fax: (414) 784-4935 Group # 1533003F3301 (Medicare) |
| CLAIMS APPEALS | RESPONSIBILITIES | CONTACT NUMBERS |
| Claims Appeals (including complaints
and/or questions about plan interpretation. (See Articles 1, 5 and 9.) Normal Business Hours: Mon -Thurs.: 7:00 a.m. - 5:00 p.m. Fridays: 7:00 a.m. - 12:00 noon |
Please submit all appeals in writing
by regular mail, fax or E-mail and allow 10-30 days for processing. For
complaints or questions on the plan, contact the Compliance Office. Hotline:
(888) 679-2400 EXT 5 Fax: (770) 926-0031 E Mail: compliance@nhai.net Please be advised: when sending us email, you should also email a copy to yourself for your records. |
Mail Address - Do not send Certified.
If you want a receipt send priority mailing with proof of mailing. Compliance Office Attn: Gloria Gillespie 416 Creekstone Ridge Woodstock, GA. 30188-1753 Phone: (800) 645-1195 |
| Claims Appeals concerning Pre-certification and/or Medical Necessity - call the Pre-certification Office immediately. Emergency situations will be processed within 24 hours during normal business hours. | The patient or member with the Compliance Office must file appeals concerning benefit payments or plan interpretation by the provider or directly. | Please allow a minimum of 10 to 30 days to review your claim once all information is submitted including a copy of the claim in question and the EOB. This may be sent via e-mail, fax, or regular mail. |
| ENROLLMENT & COBRA INFORMATION | CHANGE OF STATUS | WHERE TO ENROLL/FILECHANGES/ FORMS |
| COBRA, Enrollment, Change of Status, Student Verification Normal Business Hours, except for Holidays: 9:30 a.m. - 4:30 p.m. | Forms, PPO directories, general information and COBRA. You must notify Trust within 60 days of any change in family status. Failure to notify us of a change may result in ineligibility for COBRA benefits. | Compliance Office Phone: (800) 645-1195
fax: (770) 926-0031 e-mail: compliance@nhai.net Please be advised: when sending us email, you should also email a copy to yourself for your records. |